The president as a patient: The Hippocratic Oath still applies

The president must answer to the American public. But he is also a private citizen and is entitled to patient privacy under our federal Health Insurance Portability and Accountability Act (HIPAA) laws. These two concepts may come into conflict when a president is acutely ill, as President Trump is now from COVID-19.

Prolonged periods of hypoxia could render him unable to think clearly, though that definitely does not appear to have been the case with President Trump. Reported brief episodes on Friday of dipping oxygen saturation levels were quickly treated. By Saturday morning, after he had been fully settled into Walter Reed National Military Medical Center, his oxygen saturation was reported as normal, his fever was gone and the president did not require oxygen at all.

What about his lungs and other major organs? COVID-19, in a sense, is actually two diseases rolled into one. First, it is a highly transmissible respiratory virus that frequently causes coughing and fever and gastrointestinal problems. But then, as it progresses — and especially in moderate to severe cases more common in those over age 70 or obese, as is President Trump — it may inflame the lungs and inner lining of blood vessels, leading to damage to major organs and/or blood clotting. Sources have told me that a CT scan of the president’s chest was performed (along with several ultrasounds). I don’t know what these results showed. Still, Dr. Sean Conley, the president’s physician, informed me in an email that, in considering discharging the president from the hospital on Monday, “with all the staff and expertise we have downtown at the [White House], we’ll be able to support him until he’s clear of the virus and back to full strength.”

I suspect that he is not currently requiring oxygen and lacks a fever were key factors in this decision, and I am hoping (and suspect) that it also means his imaging studies and blood tests are normal. Since I have never seen his chart, I can’t say how long I would have kept him hospitalized if he were my patient. As a patient, the president has a responsibility to take his illness seriously, face it with courage and fortitude (as he appears to be doing), and not put others at risk by interacting with as few people as possible during the infectious period. Anyone near him needs to wear full personal protective equipment (N95 mask, face shield, gown, gloves) and know how to use it properly. This is just as true now that he is back at the White House as when he was at the hospital.

And we in the public health community have a responsibility too. I am dismayed when I see physicians opining in the media about the president’s condition and how it is being handled, without those individuals having all of the facts. We don’t know how sick he was, or why he received the antiviral drug remdesivir or the synthetic monoclonal antibody treatments (which block the virus from entering our cells) or, for that matter, the steroid treatment dexamethasone (to suppress the associated inflammation), other than that scientific data has shown these treatments to be at least somewhat effective in fighting COVID-19. Trump’s use of these treatments can be seen as either cutting-edge or excessive, depending on how you look at it and his actual condition when the treatments were initiated. But, here again, we don’t have enough clinical information to know. 

As for those doctors who say the use of the steroid dexamethasone supposedly rendered the president incapable of performing his job, I would ask how many patients these same doctors have treated in their practices for whom this wasn’t, in fact, the case. I have found that steroids are very well tolerated by most patients and do not interfere with their ability to function. True, the president’s doctors need to be on the lookout for changes in behavior — but if we removed everyone on steroids from the workforce, we likely would be severely hampered. 

The physicians I most respect are those who do not judge their patients or how they got sick but who, instead, do their best to help them heal. At the very least, we owe that courtesy to the United States president, who, as a patient, should not be made an exception to our Hippocratic Oath.

Marc Siegel, M.D., is a professor of medicine and medical director at Doctor Radio at NYU Langone Health. He is a Fox News Medical Correspondent. Follow him on Twitter: @drmarcsiegel.